By and For Those With Private Disability Claims

Living With A Disability Claim – Field Visit Investigations

Unfortunately, this is the time of year for increased requests for insurance field visits, and it’s no picnic. Looking for reasons to deny claims, insurers hire private investigators to solicit information from unsuspecting insureds in an effort to increase profitability by year-end.

It’s no secret that insurance field visits are intended to entice insureds and claimants to provide information that could be used against them. I was reminded of how invasive field investigations are for insureds when one of my clients recently attended a Unum field visit and then shared with me, “I feel like I need a bath.”

It does feel a little bit like that doesn’t it? It’s not easy to meet with a stranger knowing in advance that if you say or do the wrong things you may lose your only income. Yet, for most insureds field visits are contractual duties and therefore insureds are required to allow themselves to be interviewed even when they know it’s not in their best interests.

Requests for field interviews are usually made by the claims reps when a “red flag” is raised on a claim. “Red flags” are issues, facts, evidence, or inconsistencies that occur suggesting to the claims manager that an insured has not been honest, has unreported business and/or earnings, is working, or has otherwise exaggerated physical capacity.

Field interviewers are cued by the claims manager to ask specific questions to “catch” insureds in what is called “inconsistency of report”, or simply telling a lie. The field interviewer presents as though he/she is the insured’s long lost buddy and that you both have a great deal in common. This technique assures that you, the insured, feels comfortable to share information that perhaps has nothing to do with your claim. Or, does it?

When I was a Unum trainee, the field investigator described his “gotcha” techniques that included pulling change from his pocket and asking the insured, diagnosed with cognitive deficit, to count it. Or, the claimant who just told him she couldn’t walk without her cane, but then went to the kitchen to get him a glass of water when he asked for it without it. Field investigators have their own “bag of tricks” and quite often the whole point to the interview is to encourage and entice deception by setting the stage through friendly dialogue.

Claims representatives “sell” field investigations as opportunities for their companies to “ask additional questions” or “obtain information they do not have.” At one time Unum sold field visits as opportunities for YOU to ask questions. Regardless of how field investigations are sold to insureds and claimants, the goal is always the same – to obtain information out of the mouths of babes that can be used adversely to deny claims. No wonder people feel as though they need a bath.

In my opinion the most devastating effect of field visits is when it is used to discredit insureds after previously conducting surveillance. Suppose surveillance showed the insured walking in a local Mall for more than an hour. During the field visit the investigator asks, “How far do you think you can walk, and for how long?” The insured responds, “I can’t walk at all and I stay home most days.” Obviously, there is deception here and hence the purpose of the field visit has been successful in discrediting statements made by the insured.

Although field visit reports aren’t generally used alone to determine whether a claim can be denied or not, they can be a very important final cap on an otherwise weak claim targeted as non-compensable. It’s important for insureds not to create “inconsistencies” that lead to red flags.

This is one reason why an important “best practice” is not to speak to insurance representatives on the phone but to insist on all communications in writing. Those who are taking pain medications and certain antidepressants can inadvertently communicate information differently from one phone conversation to the next.

The bottom line here is that insurance field visits are considered “risk management activity” by the insurance company, and bad news to insureds. As a claims consultant I understand and validate the feelings of insureds who find themselves subject to interrogations when everything that can go wrong, does.

Like surveillance, field investigations are invasions of privacy and often include questions about the most private and emotional parts of one’s lives, families, and mental states of being. Personal privacy is very dear to most people and yet it’s not surprising that it is the very thing that is used against insureds when they file claims to obtain benefits owed. I have said many times that disability insurers know little to nothing about disability.

Unfortunately, living with a disability claim includes the possibility of field visits for most insureds throughout the duration of most policies. Insureds can and should be prepared for field interviews, but the feelings of privacy invasion and deception may remain.

Remember, although the field visit process is directly intended to ask questions about insured’s personal lives, the activity itself isn’t personal. The insurance company is looking for information it can use to shut down claim financial reserves in order to bolster profits.